Your instructor hit it right on the head. It is very easy to argue what you do in the real world vs what you should answer on the test. You go with the choice that you would do at work and that is often the wrong answer. If you read a question, you use only the information given to you. Anything else does not exist. If it asking about safety, you don't pick the heart rate choice because the heart rate is important, in general. You pick the answer about safety. If it is asking about bowels sounds, you answer with the choice that refers to bowel sounds.
Don't imagine one thing leading to another in a question scenario. "If I don't do this, then this will happen, and then this, so, this answer is right because that is the worst thing that can happen and I never would want that." You simply pick the answer to the question....even if it is simple.
Find out what the question is asking. Is it a question about assessment, intervention, evaluation, safety, etc? There will usually be a choice with airway, breathing, circulation, but that is not always the correct answer. ABC's aren't the answer unless the question is asking about ABC's.
Anything you do at work will never factor into your test. When I was school, there were students who argued every answer on the test with " well, that's not what I would do" or "I would hook them up to oxygen...I wouldn't ambulate them, that doesn't make sense..ABC's!" But, the question had nothing to do with ABC's. Nursing exams don't care what you would do or what would happen in the real world. They are testing your ability to answer the question with critical thinking.
Pick out the important information. If a question is asking how well a pt responded to a medication, the oxygen level or heart rate doesn't matter. They will toss a oxygen saturation on there and it has nothing to do with the question. Read the question first and pick out the information you need to answer the question.
Approach the question as if it's are trying to trick you. Many times, it is trying to trick you. Take a step back and look at it from a different angle. Assume there's a curve ball. Sometimes, the answer is one step away from the obvious answer. Remember, the people that are writing these questions are trying to be sneaky...um... challenging. The last thing they want to do is be obvious. You approach the question, knowing it's kinda shady.
Sometimes, the story lies in the answer choice. It can be the missing link to the scenario you just read. I had one question like this...
You gave a pt with angina a dose of cardizem, how do you know it was effective? The choices were...
respiratory rate decreased,
the respiratory rate increased,
the chest pain subsided,
the heart rate decreased.
At the time, I couldn't recall what cardizem exactly was. I knew it was a calcium channel blocker because it mentioned a decreased heart rate. CBB don't do anything with resp, so I had a 50/50. CBB do, in fact, lower the heart rate. So, I went with that. Right when I was about to click that, I stopped. Something wasn't right. Hmmm, chest pain subsided. That was it. I went to click that, then I stopped. But, if someone has chest pain and their heart is pumping away, that will lead to increase myocardial demand, which will surely cause chest pain. If you slow that down, that will make the chest pain go away. So, I stepped back, looked at the question, knowing it was trying to be clever.
What is the question asking? It is asking me the effectiveness of a medication for someone that has chest pain. I don't use any more information other than what is given to me. The fact that is was a CBB had nothing to do with it. Nothing. And I fell into the "this leads to this, which ultimately causes this, so the answer is this" gag. It simply wanted to know how I would know if a medication was effective for chest pain. The answer was...the chest pain subsided. The heart rate was the curve ball. I was evaluating the angina, not the heart rate.
That's what you do. Use just what you have in front of you. Critical thinking is a process....it uses steps. You use specific thinking. Specific to the question. The real world doesn't apply. And many times, you will have absolutely not idea what the scenario means or you can't remember a lab value, but you can pick out the right answer if you know how test questions work. Sometimes, the words in the answer don't matter as long you pick the assessment answer to the assessment question. That;s how you can answer a question that they skimmed over. You instructors like using topics they covered well and ones they didn't really cover. You can still answer the question if you can pick at it.